I/we enclose a cheque/P.O. for £..................as subscription for the current subscription year(made payable to ANLHS)

NAME (capitals please)........................................................................................................

ADDRESS (capitals please).......................................................................................................................................................................

...........................................................................................................................................................POSTCODE..................................

EMAIL...............................................................................................................................................

SIGNATURE ......................................................................... OFFICE (where relevant eg Secretary)........................................................

NAME OF SOCIETY/INSTITUTION (where relevant)...............................................................................................................................

Please PRINT OUT then complete this form, and send with your payment to:

Mr. M. Thompson, 21, Melrose Avenue, Seaton Delaval, Northumberland.  NE25 OJR.